Editor:
We read with great interest the report, “Asperger's Disorder and Murder,” by Dr. Schwartz‐Watts.1 Her article highlights the increasing psychiatric interest in Asperger's Disorder (AD) and criminality,2–5 and the need to clarify our current knowledge base in this area. To enhance forensic appreciation of this fascinating area, we would like to make the following points.
Recent reviews of AD and its association with violence, written from different perspectives, suggest that an association between AD and violence may exist.2–5 Other important contributions in this area have also appeared during the past two decades.6–7
In addition to the study by Siponmaa and colleagues2 discussed by Dr. Schwartz‐Watts, a broad screening survey of an adult forensic population found a prevalence rate of between one and three percent for AD.8 Also, the most comprehensive and technically sound work concerning the epidemiology of Asperger's Disorder provides a prevalence of pervasive developmental disorders other than Autistic Disorder of 0.367% (or 36.7 per 10,000).9 These results, coupled with the work of Siponmaa and colleagues,2 support the idea that both AD cases and individuals with PDD NOS are at elevated risk for violent acts compared with the general population and that the number of individuals who suffer from autism and engage in violent crimes may be substantially higher than 2.5 per 10,000. Dr. Schwartz‐Watts makes an important point when she states that there is a need for well‐trained psychiatrists to recognize and diagnose PDD spectrum disorders, including AD. As forensic clinicians deepen their investigation into these disorders and violent crime, it will be crucial to identify various risk factors in subgroups of affected persons. For example, a murder may be perpetrated by a person with Asperger's Disorder who has substantial difficulties in appreciating the killing of a victim. His actions may be clarified by taking into account paradigms traditionally used to understand Asperger's Disorder, such as deficits in theory of mind, central coherence or executive dysfunction.10–12 The extreme‐male theory of autism may also shed light on the nature of crime in individuals with Asperger's Disorder.12
Dr. Schwartz‐Watts mentions diminished capacity statutes as relevant to defendants with AD. We agree. There are many areas relevant to culpability and sentencing that may be affected by a PDD diagnosis. Given the deficits in the ability to read social situations and appreciate the points of view of others in AD, some affected defendants may qualify for criminal responsibility defenses of a psychiatric nature.
Finally, Autism Spectrum Disorders have a high heritability,13 and are thought to have robust underlying neuropsychiatric bases.11,12,14 Therefore, comprehensive forensic psychiatric evaluations in AD may necessitate diagnostic interventions, such as specialized neuropsychological testing and the collection of comprehensive psychiatric family histories, to help clarify the biological nature of cases of AD associated with violence.
- American Academy of Psychiatry and the Law
